Pathology Report Questions

[Suzo]

Q1.  Is it common practice to not perform a sentinel node biopsy on cases like mine?  I'm  concerned that perhaps the pathology report may have been in error concerning the not multifocal nature of the cancer since in the operation report my surgeon stated: "There was potentially one small additional calcification visualized (radiographically) which appear to have an adequate margin."
Q2. Am I being paranoid insisting that I someone takes another look at the tissue?
Pathology
- reported after stereotactic biopsy: DCIS, Grade II/III, cribriform pattern w/necrosis; intraluminal mircocalcifications.
- reported after the lumpectomy (2 speciums):  (A needle directed biopsy) focal residual DCIS, MSBR Grade II/III, with necrosis, adjacent to prior biopsy site; DCIS measures ~.3cm in greatest dimension; DCIS approaches within .1cm of the lateral surgical margin; no invasive tumor identified; fibrocystic changes. (B designated lateral, reexcision): intraductal hyperplasia w/o atypia; fibrocystic changes; no in situ or invasive carcinoma identified.
Comment:  The DCIS seen in part A comprises on major and scattered very small foci of noncomedo type which are all adjacent to the biopsy sidt and which are interpreted as being part of the DCIS  prior biopsy (i.e., not multifocal disease)Although the DCIS closely approaches the lateral aspect of specimen A, specimen B (verbally designated by the surgeon as an additional excision just lateral to specimen A: contains no DCIS, and therefore the margins are interpreted as negative.

[CCF-RN,MSN-JS]

Dear Suzo, It sounds like the area that the surgeon referred to in the surgical report "There was potentially one small additional calcification visualized (radiographically) which appear to have an adequate margin."  is being referred to in the pathology report as "Although the DCIS closely approaches the lateral aspect of specimen A, specimen B (verbally designated by the surgeon as an additional excision just lateral to specimen A: contains no DCIS, and therefore the margins are interpreted as negative."  Thus the communication between the surgeon and the pathologist helped to determine that adequate margins were obtained.  You could discuss this with your surgeon particularly for your peace of mind.  If you are still concerned, getting a second opinion on the pathology is an option for you.

As there is no evidence of invasive cancer a sentinel lymph node biopsy would not be done.

[Suzo]

Typo corrections to pathology report:

"Comment: The DCIS seen in part A comprises ONE major and scattered very small foci of noncomedo type which are all adjacent to the biopsy SITE and which are interpreted as being part of the DCIS prior ..."

[Suzo]

Thanks for your reply and also for this site it has been very helpful to me.  I had already discussed the pathology report with my doctor.  I had read in Dr Susan Loves Breast Book, 3rd Edition, p161-162, How to Read Your Biopsy Report that "you want to make sure that the pathologist saw calcifications under the microscope...sometimes...when they make the slides they don't get the area where the calcifications are."  I showed this page to my surgeon and he thought that perhaps the calcifications they saw when the looking at tissue at the time of the surgery with xray..were nothing more than a glitch in the film.  It is difficult to accept on faith that all is OK, when there always seems to be a bit of a "may," "probably" or other equivocating words when describing results.  Sure would be comforting to know without a doubt, but I guess breast cancer isn't like that.